Gingival Melanin Pigmentation Research Articles

Relationship of skin complexion with gingival tissue color and hyperpigmentation. A multi-ethnic comparative study

Background and ObjectiveThe most frequently seen intra-oral soft tissue is the gingiva. Most often, it is seen as coral-pink tissue that surrounds the neck of the teeth. Gingiva that encircles the tooth necks and covers the alveolar processes of the jaws is an intra-oral tissue that exhibits biomimetic features. The wide range of colors of the gingiva depends on the configuration of gingival vascularity, the degree of epithelial cornification, level of melanogenesis, and the depth of epithelialization. However, the color of the gingiva varies depending on the degree of melanin pigmentation. The current study aimed to identify the different distribution patterns of gingival color and determine the correlation between skin color, gender, and geographical area of origin.Materials and methodsA total of 839 subjects were involved in the study where the gingival color and skin tone were measured using the Dummett-Gupta Oral pigmentation Index (DOPI) combined with VITA VMK MASTER and skin shade method developed by Revlon (USA) and L’Oreal (France) for makeup foundation shades. One investigator was calibrated for the examination of the colors after being tested for normal color vision and color aptitude using the line test.ResultsA significant association was found between skin color and gingival pigmentation (χ2 value (6) = 114.48; P = 0.001). It was also found that females (67.1%) significantly had darker gingiva than males (58.3%). The study statistics display that location of the individual was also statistically associated with melanin pigmentation of the gingiva (χ2 value (57) = 559.33; P = 0.001).ConclusionThe study concluded that gender, skin color, and individual location are significantly associated with gingival melanin pigmentation.

Laser de alta potência no tratamento da pigmentação gengival: uma revisão integrativa da literatura

ABSTRACT Objective: To perform an integrative literature review about effectiveness of high-power laser in the treatment of gingival melanin pigmentation. Methods: This research consists of an integrative review conducted from September 2021 to May 2022 seeking to answer the following question: “What is the clinical effectiveness of laser in the treatment of gingival melanin pigmentation?”. The articles were analyzed by two researchers and the information about these was collected with emphasis on the following data: authors, year of publication, study objectives, methodology, results and conclusion. Results: Of the 16 articles initially selected, 08 were excluded (3 literature reviews, 4 internship reports and 1 monography). Thus, 8 articles were selected. Conclusion: Among several types of lasers and techniques for its use, laser, especially diode laser, was the most used technique and presented better aesthetic results, less pain, faster healing, preference and patient satisfaction after treatment. More good quality randomized control trials are needed in different techniques currently used to generate conclusions with high scientific evidence.

Gingival Depigmentation

A pretty smile enhances an individual’s self-confidence. A smile express joy, success, affection and or even say hello and reveals self-confidence and kindness. Gingival melanin pigmentation is one of the factors which determine the smile of an individual. Excessive gingival pigmentation is a major esthetic concern for many individuals. Gingival pigmentation occurs in all races of man and it varies from one race to another. It may vary depending on whether it is physiological or pathological. Melanin pigmentation of the gingiva is completely benign and it does not present a medical problem, complaints of ‘black gums’ are commonly seen in patients having high smile line (gummy smile). Different treatment modalities are reported for depigmentation of gingiva; which includes cryosurgery, electrosurgery, laser and scalpel surgical technique.

Validity and Reliability of Polarized vs Non-Polarized Digital Images for Measuring Gingival Melanin Pigmentation.

This study aimed to compare the validity and reliability of polarized and non-polarized intraoral photography for the measurement of gingival melanin pigmentation. A case series study was conducted on ten patients scheduled for gingival depigmentation. A total of 976 polarized and non-polarized image samples were collected, capturing two rows above the gingival margin, for analysis. These images were taken both before and one year after the depigmentation procedure. Three independent evaluators assessed the photographs (an orthodontist, a general dentist, and a layperson). The Dummett Oral Pigmentation Index (DOPI) and Gingival Melanosis Record (GMR) indices were used to measure the level of gingival pigmentation. The study found no significant differences between polarized and non-polarized images taken before and after depigmentation. Both methods of imaging received similar scores from the evaluators. The orthodontist identified more pigmented slides than the layperson and the general dentist. Both polarized and non-polarized photographic methods may be used for assessing gingival pigmentation. However, further research is warranted to confirm this finding and examine additional factors.

Gingival Pigmentation Features in Correlation with Tooth and Skin Shades: A Cross-Sectional Study in a Saudi Population.

The present study aimed to observe the anatomical distribution of gingival melanin pigmentation and evaluate its intensity and extent in different age groups and in correlation with skin and tooth shades. The participants of this study were 391 patients attending the Dental University Hospital. The presence of gingival pigmentation was assessed using De Krom's Oral Pigmentation Chart and its intensity was assessed using the Dummett-Gupta Oral Pigmentation Index. Skin colour and tooth shade were measured using the Fitzpatrick scale and the VITA classical shade guide, respectively. Statistical analyses included descriptive statistics and Pearson's Χ2 test for the association between the study variables. The prevalence of gingival pigmentation among the sample size was 74.4%, and pigmentations were present on both arches in 57.6% (n = 224) of the participants. The extent (category 1) was highest when pigmentation was evident in both arches, with category 4 being the least extent. Age and sex did not show a correlation with gingival pigmentation. Gingival pigmentation intensity was mild when pigments were present in one arch (p < 0.00), whereas it was heavy when both arches presented with gingival pigmentation. Medium brown colour and tooth shade A1 were the most common among participants with gingival pigmentation (p < 0.00). The association between gingival pigmentation intensity and extent in relation to skin colour was statistically significant (p < 0.00), as was tooth shade (p < 0.05). Gingival pigmentation is highly prevalent in the Saudi population, with different severity and extent levels. The effect of gingival pigmentation on smile and overall facial aesthetics should be considered when providing dental and cosmetic treatments.

Aesthetic Gingival Melanin Pigmentation Treatment in Smokers and Non-Smokers: A Comparison Study Using Nd:YAG Laser and Ceramic Bur.

Aesthetic concerns are increasing rapidly; thus, several approaches have been suggested for treating gingival melanin pigmentation. Lasers have been reported as an effective new tool, and the Nd:YAG laser beam has an affinity for melanin and haemoglobin. However, ceramic gingival bur is simple and has less bleeding effect during operation than conventional techniques. This study aimed to compare the outcomes of gingival depigmentation using the Nd:YAG laser and ceramic bur in two different groups (smokers and non-smokers). A total of 40 patients presenting with gingival melanin pigmentation were enrolled in this split-mouth study. The sample was divided into two groups: smokers and non-smokers. Treatment was performed using the Nd:YAG laser (3 W, 60 mJ/pulse, and 50 Hz) and ceramic bur with a one-week interval between the two methods. Clinical indices were recorded, including intraoperative bleeding, wound healing, post-operative pain, and the recurrence of pigmentation, and follow-up periods were determined in the 3rd, 6th, and 9th months postoperatively. Both treatments promoted a similar pain experience and recurrence rate of pigmentation (p > 0.489, p = 1.000, respectively). Bleeding during surgery and complete healing recovery after one week were statistically significantly higher when using ceramic bur (p = 0.00, p = 0.041, respectively). Concerning the effect of smoking on the treatment, a higher recurrence rate was observed in SG than N-SG in laser sites (50%, and 95%, respectively) and bur sites (60%, and 85%, respectively), but statistically no significant difference was observed (p > 0.080). In conclusion, both procedures are adequate for aesthetic gingival depigmentation treatment. The Nd:YAG laser showed greater effectiveness in controlling bleeding, while ceramic bur showed a faster clinical recovery. Furthermore, smokers were more likely to have low depigmentation treatment stability.

CLINICAL FEATURES OF GINGIVAL HYPERPIGMENTATION IN VIETNAMESE OUTPATIENTS

Background: Gingival esthetics was considered one of the most significant aspects of aesthetic smiles, especially in those with gingival hyperpigmentation. Understanding the features, distribution, and causes impacting gingival pigmentation was critical for developing an effective treatment plan. Objectives: The prevalence of gingival hyperpigmentation in outpatients at Can Tho University of Medicine and Pharmacy Hospital; the association between gingival hyperpigmentation and age, gender, smoking status, and skin color. Material and Methods: Descriptive cross-sectional method; convenience sampling. Results: In a total of 100 outpatients, the rate of gingival hyperpigmentation was 53%, of which 40% had mild gingival hyperpigmentation according to DOPI (grade 1), 13% had moderate gingival hyperpigmentation (grade 2), and 13% had heavy gingival hyperpigmentation disease (grade 3). The study collected 3/6 groups of gingival melanin hyperpigmentation according to Ponnaiyan's classification. Of all the hyperpigmentation groups according to Hedin's classification, the hyperpigmentation group forming a long continuous ribbon accounted for a high proportion (45% in the maxilla, 40% in the mandible). The rates of gingival hyperpigmentation in the group of 40-year-old patients and the others were 48.8% and 75%, respectively. Conclusion: There was a statistically significant relationship between gingival melanin pigmentation and skin color. The percentage of melanin pigmentation was higher in those with dark skin. There were no differences in the ratios for age, gender, or smoking status.

Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial.

This investigation has aimed to compare the efficiency of clinical depigmentation and repigmentation rate of erbium chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) and diode lasers during a 1-year follow-up and to evaluate patient satisfaction. Twenty-two participants were divided into Er,Cr:YSGG laser and diode laser groups using computer-aided randomization. Dummett Oral Pigmentation Index (DOPI) and photographic assessment with ImageJ Software version 10.2 were performed at the preoperative period and postoperative 1st month, 6th month, and 12th month. Moreover, the study assessed intra- and postoperative intensities of pain and postoperative patient aesthetic satisfaction using the Visual Analog Scale in both groups. The median values of DOPI did not differ statistically between the groups according to time (p > 0.05). In the Er,Cr:YSGG group, the extension of repigmentation was less as compared to the diode group at 1-year follow-up (p = 0.045). In the Er,Cr:YSGG group, the patients felt less intraoperative pain and discomfort compared to the diode group (p = 0.007). No significant differences were found between the two groups in terms of patient aesthetic satisfaction at the 1st and 12th months. The findings indicate that diode and Er,Cr:YSGG lasers can be used safely in depigmentation treatment, while the Er,Cr:YSGG laser has been shown to have superiorities in pain management and patient comfort parameters. Clinical Trial No.: NCT05304624.

Use and Success Rate of Lasers in the Treatment of Gingival Melanin Pigmentation: A Systematic Review

The pigmentation of oral soft tissues is predominantly an aesthetic problem because lifestyle, media, and social influences impact people&#39;s perception of beauty, which in turn affects their self-esteem as well as their relationships. The melanin pigmentation of the gingiva has become a real concern in the Gulf region, especially for younger people and females, who seek aesthetic solutions to remove the pigmentation. The pigmentation caused by melanin can be removed by surgical blades, diamon

Evaluation of Carbon Dioxide Laser-Assisted Treatment for Gingival Melanin Hyperpigmentation.

Smile aesthetics has a vital role to play in an individual's life and one of the factors affecting the beauty of the smile is gingival color. A gingival color change or gingival hyperpigmentation causes an unesthetic smile line, especially in patients with a gummy smile, which is also known as a black gummy smile. Numerous gingival depigmentation methods have been performed successfully for ablating gingival melanin pigmented epithelium. Thus, the aim of this study is to evaluate the treatment efficacy of gingival hyperpigmentation by using a carbon dioxide (CO2) laser. A cross-sectional descriptive study was carried out with 38 patients at a hospital in Vietnam. Ponnaiyan classification and the Hedin melanin index were used to assess the distribution and extent of gingival pigmentation in the study. Pain assessment was performed using the Visual Analog Scale (VAS) to evaluate the intensity of pain during the laser treatment. In addition, clinical evaluation (i.e., wound healing) of each treatment procedure was conducted using the three level Dummett-Gupta Oral Pigmentation Index (DOPI) assessment. This study showed that less pain was experienced by patients treated by CO2 laser; the rates of no pain, mild pain and moderate pain after treatment were, respectively, 21%, 76% and 2.6%; there was 100% complete epithelization after 1 week. The DOPI rates for turning from a DOPI score of 1, 2 or 3 to a DOPI score of 0 after a 12-week treatment were 87.5%, 76.9% and 24%, respectively. Using a CO2 laser for gingival melanin pigmentation treatment is a safe and effective procedure.

Reconnoitering the Association of Gingival Melanin Pigmentation With Skin Color, Age, and Sex in Pre-School Children of Hazaribag: A Cross-Sectional Study.

Introduction The purpose of this study was to compare and evaluate the association of gingival melanin pigmentation with age, sex, and skin tone in pre-school children of Hazaribag, Jharkhand, India. Materials and methods The study included 310 children aged 3 to 6 years, who were divided according to skin color into the following: group I: Fair, group II: wheatish, group III: brown; and group IV: dark. The children were selected using a census method where all participants fulfilling inclusion criteria were selected from the outpatient department of the Department of Pediatric and Preventive Dentistry, Hazaribag College of Dental Sciences and Hospital, Hazaribag. The subjects were further grouped into different age groups of 3-4 years, 4-5 years, 5-6 years, and 6 years. Subjects were examined in natural daylight, and gingival melanin pigmentation was assessed using the Dummett-Gupta Pigmentation Index. The scoring was done for each arch segment. These categorical data were analyzed using the chi-square test. Results Gingival pigmentation was found to increase with increasing age, whereas female subjects showed less pigmentation than males. Majority of the children had wheatish complexion, and a significant positive correlation was found between skin tone and gingival pigmentation; the darker the skin tone, the darker was the gingival pigmentation. Anatomically, greater pigmentation was found in the anterior than posterior region of arches. Greater pigmentation was found in the labial than lingual region; greater pigmentation was also reported in the mandible than maxilla. Conclusion There was a positive correlation of gingival melanin pigmentation with age, sex, and skin tone in pre-school children. Clinical significance The association of gingival pigmentation with skin color had been documented, but very few studies have been published on adults and children on this subject. However, there is no study that evaluates the association of gingival melanin pigmentation with age, sex, and skin tone of children of pre-school age.

A Comparative Clinical Evaluation of Surgical Blade Abrasion and Partial Thickness Flap as Treatment Modalities for Gingival Pigmentation.

Gingival hyperpigmentation is a major esthetic concern for many people, although it is not a medical problem, many people complain of dark gums as unesthetic. Gingival depigmentation is a periodontal plastic surgical procedure that removes or reduces hyperpigmented gingiva. Various methods like scalpel, free gingival autografts, electrosurgery, cryosurgery, and abrasion with diamond bur gingival hyperpigmentation is a major esthetic concern for many people, although it is not a medical problem, many people complain of dark gums as unesthetic. Gingival depigmentation is a periodontal plastic surgical procedure that removes or reduces hyperpigmented gingiva. Various methods like scalpels, free gingival autografts, electrosurgery, cryosurgery, abrasion with diamond bur, and various types of lasers have been used for cosmetic therapy of gingival melanin pigmentation. This article compare the efficacy of gingival melanin depigmentation done by excision with a surgical blade using scarping and partial thickness flap technique. and various types of lasers have been used for cosmetic therapy of gingival melanin pigmentation. This article compares the efficacy of gingival melanin depigmentation done by excision with a surgical blade using scarping and partial thickness flap technique.

GINGIVAL DEPIGMENTATION USING SIMPLE DE-EPITHELIZATION BY BUR ABRASION TECHNIQUE - A CASE REPORT

Dentofacial esthetics demands have increased tremendously in the past decade. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with the challenge of achieving gingival esthetics. Melanin pigmentation of the gingiva occurs in all races. Gingival hyper-pigmentation is seen as a genetic trait in some populations and is more appropriately termed physiologic or racial gingival pigmentation. Pigmentation of gingiva not just has an impact on esthetics but also creates psychological negativity.Treatment of gingival melanin pigmentation can be done using scalpel, chemical agents, abrasion, grafts, electro surgery, cryosurgery or lasers. Recent reports on treatment of gingival melanin pigmentation using bur abrasion method which shows results in terms of ease of use, acceptance and patient comfort to be far superior to other techniques.

Management of gingival hyperpigmentation using three different techniques: A case series

Although the colour of the gingiva plays a vital part in overall aesthetics, the ideas and strategies for treating problems caused by gingival melanin pigmentation are still being worked out. Clinicians are confronted with obtaining acceptable gingival aesthetics as well as resolving biologic and functional difficulties as aesthetics has become an important element of dentistry. This case report discusses three different de-epithelization treatments that have been effectively utilised to treat gingival hyperpigmentation caused by excessive melanin deposition, as well as the importance of having an aesthetically pleasant smile, especially for smile aware people. Creating esthetic awareness among dental practitioners about various treatment modalitites for the management of gingival hyperpigmentation.

Relationship between Knowledge of Periodontal Disease and Gingival Melanin Pigmentation and Smoking Behavior

Abstract: Tobacco use in Indonesia is still relatively high among teenagers-adults or the average of university students. There is a relationship between smoking and periodontal tissue parameters as well as gingival melanin pigmentation. This study aimed to determine the relationship between the knowledge of periodontal disease and gingival melanin pigmentation and smoking behavior among college students. This was an analytical and observational study with a cross-sectional study design. Samples were 108 undergraduates of Diponegoro University batch 2018-2020 who met the inclusion criteria, obtained by using purposive sampling and non-probability sampling techniques. Data were collected by using an online questionnaire through the Google platform regarding the knowledge of periodontal disease and gingival melanin pigmentation on smoking behavior. The data were analyzed by using the Spearman Rank Correlation Test. The results showed that the students’ knowledge about periodontal disease and gingival melanin pigmentation was in a good category, meanwhile students’ smoking behavior was in the moderate smoker category. The Spearman Rank correlation test showed no significant correlation between knowledge of periodontal disease and gingival melanin pigmentation with smoking behavior (p=0.403). In conclusion, there was no significant relationship between the knowledge of periodontal disease and gingival melanin pigmentation and smoking behavior.Keywords: knowledge; behavior; smoking; periodontal disease; gingival melanin pigmentation Abstrak: Penggunaan tembakau di Indonesia masih tergolong tinggi di kalangan usia remaja-dewasa atau rata-rata usia mahasiswa. Terdapat keterkaitan antara merokok dengan parameter jaringan periodontal dan perubahan pigmentasi melanin gingiva. Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan penyakit periodontal dan pigmentasi melanin gingiva dengan perilaku merokok mahasiswa. Jenis penelitian ialah observasional analitik dengan desain potong lintang. Sampel penelitian ialah 108 mahasiswa Strata 1 Universitas Diponegoro angkatan 2018-2020 yang memenuhi kriteria inklusi diperoleh dengan teknik sampel purposive sampling dan teknik pengambilan sampel non-probability. Pengambilan data dilakukan dengan menggunakan kuesioner online melalui platform Google form tentang pengetahuan penyakit periodontal dan pigmentasi melanin gingiva terhadap perilaku merokok. Analisis statistik menggunakan uji korelasi Spearman rank dengan menggunakan aplikasi statistik SPSS. Hasil penelitian mendapatkan tingkat pengetahuan penyakit periodontal dan pigmentasi melanin gingiva mahasiswa dalam kategori baik, dan untuk perilaku merokok mahasiswa termasuk dalam kategori perokok sedang. Uji korelasi Spearman rank menunjukkan bahwa tidak terdapat hubungan bermakna antara pengetahuan penyakit periodontal dan pigmentasi melanin gingiva dengan perilaku merokok (p=0,403). Simpulan penelitian ini ialah tidak terdapat hubungan bermakna antara pengetahuan penyakit periodontal dan pigmentasi melanin gingiva dengan perilaku merokok pada mahasiswa Strata 1 Universitas Diponegoro.Kata kunci: pengetahuan; perilaku; merokok; penyakit periodontal; pigmentasi melanin gingiva

Gingival pigmentation: Concurrent assessment of distribution, intensity, and extent in a black population.

To evaluate prevalence, distribution, intensity and extent of physiologic gingival melanin pigmentation (GMP) in black individuals. For this cross-sectional study, GMP was evaluated on digital images by three calibrated examiners, according to de Krom (distribution), DOPI (intensity) and Melanin Index (extent) classifications. Descriptive statistics, Wilcoxon, Mann-Whitney, Kruskal-Wallis, Two-way ANOVA, chi square, and K-means cluster analysis were used. Seventy participants were recruited. The most prevalent GMP categories were: de Krom category 2 (34.3%), DOPI heavy intensity (57.2%), and Melanin index Degree IV (50%). Significant inter-group differences were found for age (p < 0.05) but not gender (p > 0.05). Significant correspondence/overlap was observed between classifications (p > 0.05). Three GMP clusters were identified: Cluster 1 (27%; n=19) had mild asymmetric and interspersed pigmentation; Cluster 2 (46%; n=32) had heavy pigmentation in one long continuous ribbon, with pink marginal gingiva; and Cluster 3 (27%; n=19) had heavy pigmentation in one long continuous ribbon, symmetric, and uniform. There may be overlap among GMP classification systems. In black individuals, the predominant GMP presentation is one of a broad zone of heavily pigmented attached gingiva, in a continuous strip from central incisors to canines, symmetrical across the midline, and with pink free marginal gingiva. This is the first study to analyze distribution, intensity, and extent of gingival melanin pigmentation in the same population and to integrate the various classification systems through cluster analysis. The novel findings provide a foundation for patient assessment and counseling and for future studies.

Vitamin C mesotherapy versus topical application for gingival hyperpigmentation: a clinical and histopathological study.

Vitamin C/Ascorbic acid inhibits tyrosinase enzyme causing melanin biosynthesis suppression. This study aimed to compare the efficacy of intra-mucosal injection (mesotherapy) with topical gel as non-surgical methods for managing gingival hyperpigmentation. Twenty healthy non-smokers with mild to severe hyperpigmented gingiva were randomly assigned for Mesotherapy (G1); intra-mucosal injection of ascorbic acid (1/week/3 weeks); or Gel (G2), topical ascorbic acid gel (1/day/3 months). Pigmentation index (DOPI), patient satisfaction, as well as histological analysis for Fontana-Masson-stained specimens were performed at baseline and after 6 months. Comparison between groups and changes by time were analyzed using Mann-Whitney and Friedman's tests, respectively. The median DOPI significantly decreased after 1 month in G1 (P value < 0.001, r = 0.9) compared with non-significant change in G2. No pain experienced during or after treatment in both groups. G1 patients showed significantly higher satisfaction with treatment than G2. Mean area fraction of melanin forming cells was significantly reduced in both groups after 6 months, but the effect size was higher in G1 (r = 0.886) than in G2 (r = 0.797). Vitamin C mesotherapy showed better and early effect than topical gel, and both techniques were not painful and esthetically satisfying in managing gingival hyperpigmentation. Gingival melanin pigmentation causes esthetic concerns for significant number of patients. Investigating non-surgical depigmentation techniques to decrease postoperative complications and patient discomfort, pain and long healing period associated with surgical methods would be clinically significant.

English

BACKGROUND Gingival melanin pigmentation (GMP) is a common aesthetic concern. The gold standard for depigmentation, is surgery. Recently soft tissue lasers have gained popularity. The purpose of this study was to compare and evaluate the clinical efficacy of surgical blade and laser treatment in terms of pain perception and wound healing outcomes, 7 and 14 days following the procedures for the treatment of gingival depigmentation. METHODS This 14 day follow up comparative clinical study, utilized a split mouth design, in the anterior region. Fifteen patients with moderate to heavy bilateral gingival pigmentation were included as per the criteria by Dummett et al. The patients’ right side (group 1) was treated with surgical blade and the left side (group 2) with diode laser (Picasso, AMD LASERS™) by a trained clinician. Pain perception was assessed using Visual Analog Scale (VAS) and wound healing was assessed using clinical parameters. RESULTS Data was analysed using paired t test and Wilcoxon’s signed rank test. P value of &lt; 0.05 was considered statistically significant. On day 7, more than 70 % patients had slight pain in group 1. Whereas, 47 % experienced no pain in group 2. The mean difference in VAS scores between the groups at day 7, was statistically significant. No statistically significant distinction in wound healing was observed 7 days following both procedures. No pain, and complete epithelialisation was noted in both groups on day 14. CONCLUSIONS Pain experienced by the patients was slightly more in the scalpel group compared to laser. There was no difference in wound healing between both groups. KEY WORDS GMP, Gingival Melanin Pigmentation, VAS Scale, Depigmentation, Wound Healing, Laser, Surgical Blade, Split Mouth Design

Melanin pigmented gingival tissue impairs red-light lateral scattering for antimicrobial photodynamic therapy.

Gingival melanin pigmentation is present in many African and Oriental descendant people and its occurrence in patients may interfere with the absorption and scattering of therapeutic doses of light. Antimicrobial photodynamic therapy (aPDT) is used as an adjunctive treatment for periodontitis and light irradiation may be impaired by tissue size and its melanin content. The aim of this clinical study was to measure the red-light attenuation in gingival tissue naturally pigmented with melanin. Ten patients with melanized gingival tissue were selected and irradiated by 100 mW red laser. The patients were photographed in frontal and incisal regions with a T2i camera (Canon, Japan) with 100 mm macro lens, 35 mm focal length, aperture f22, 1/100 shutter speed and ISO 200. Three randomly selected sites of each patient were used for evaluations and the irradiation values were assessed in the IMAGEJ software (NIH, Wayne Rasband, USA). Intensity in pixels was quantified in relation to the distance from the light incident point. Data were normalized and the results were presented as relative light intensity as a function of distance. The results demonstrated that red laser light is exponentially attenuated as a function of lateral distance and loses approximately 50 % of its intensity by 2.23 mm. On the other hand, the light travels 3 mm in depth to decay 50 %. In conclusion, our data suggest that melanin presence decreases optical pathway and irradiation protocols for antimicrobial photodynamic therapy in gingival tissue should consider light attenuation and depth of periodontal pockets so that efficient illumination of the target tissue occurs. Periodontal pockets bigger than 6 mm should be irradiated with more than one point.

GINGIVECTOMY AND GINGIVAL DEPIGMENTASION AFTER ORTHODONTIC TREATMENT

ABSTRACTBackground : Gingival enlargement, a terminology for an increase in the size of the gingiva, is a general feature of gingival dis­eases. Gingival melanin pigmentation does not present a medical problem, but is likely to generate a concern in aesthetic function. Although melanin pigmentation is not a chief complain, this condition still need to be corrected. Clinicians are often confronted with a challenge in achieving gingival esthetics. Purpose : This case report aims to explain how to achieve esthetical and functional demands in gingival enlargement and gingival hyperpigmentation case with gingivectomy and gingival depigmentation. Case: This surgical procedure aim to retain esthetical and functional demands. Case Management: An 18-years-old male presenting with maxillary chronic inflam­matory gingival enlargement associated with prolonged orth­odontic therapy is reported. Orthodontic appliances are factors for irritation and plaque retention that interfere oral hygiene and regulate gingival inflammation. Surgical therapy was performed to provide a better aesthetic outcome and prevent plaque retention. Conclusion: The combination of gingivectomy and gingival depigmentation can resolve gingival enlargement and gingival hyperpigmentation perfectly with close proximity to the ideal gingival condition.Keyword : Gingival depigmentation, Gingivectomy, Orthodontic